PAKISTAN: Pneumonia Season Takes Toll on Poor Children

KARACHI, Pakistan, Nov 10 2010 (IPS) - Asleep in her mother’s lap, three-year-old Amna Ghafoor looks at peace with the world. But mother and child are at Karachi’s National Institute of Child Health (NICH), and a plastic cannula inserted in the child’s tiny left wrist is a sure sign that all is not well.

The little girl has pneumonia and has been in hospital for the last six days, says her mother Zahida Ghafoor. “She had fever, was sweating and grunting,” narrates Zahida. “When she started to struggle with her breathing, I lifted her dress and found that her chest cavity was heaving up and down. That’s when I knew I had to rush her to the hospital.”

It is the second time for Zahida to have a child with the illness, which is an inflammation of the lungs. An older daughter, Aqsa, was just four months old when she had the disease. She is now seven. “She was so bad that she had to be given oxygen,” says Zahida. “I stayed in the hospital for two weeks, before her condition stabilised.”

Nov. 12 is World Pneumonia Day, and health advocates here say it is an opportunity for Pakistan to focus on an illness that kills hundreds of thousands of its citizens – many of them children and the elderly – each year. Official statistics also show that of the 15 nations that account for 75 percent of childhood pneumonia cases worldwide, Pakistan ranks third, with seven million cases annually.

The 2006-07 Pakistan Demographic and Health Survey (PDHS) says as well that of the infant and under-five mortality rates of 78 and 94 per 1,000 children respectively, 13 percent can be traced to pneumonia.

This year, however, is especially worrying health advocates. After all, millions of Pakistanis are still homeless months after catastrophic floods inundated part of the country last July. As winter approaches, many fear that the incidence of acute respiratory infections (IRI), including pneumonia, could rise sharply among the flood victims.

Related IPS Articles

“The situation for these people is really precarious,” says Dr Zulfikar Ali Bhutta, paediatrics department head at the Aga Khan University Medical Centre here. “There is the seasonality risk of contracting pneumonia now with the weather changing.”

He continues, “Even if they have gone back to what remains of their homes, the place will be damp and dilapidated, so the risk of contracting pneumonia will increase.”

Pneumonia, however, is one disease that seems to have escaped the attention of Pakistani policy makers despite its profound impact especially on the country’s children. According to Bhutta, that can be due partly to the fact that it is a “poor child’s disease”.

“Overcrowding, pollution, poor sanitation, poor handwashing practice, diarrhoea – all pointing to poverty” – are factors that make it easier for a child to fall ill with pneumonia, the doctor explains. “But of all these, malnutrition – and diarrhoea is an important cause of malnutrition – is the biggest cause of pneumonia.”

Not surprisingly, the PDHS says that 38 percent of children zero to 59 months in Pakistan are underweight.

“I’d say malnutrition is, by far, the most significant reason for the mortality (rates) due to pneumonia,” says NICH child specialist Dr Yasmeen Kazi, who adds that the illness can be caused by bacteria, viruses, fungi, and parasites.

But Dr Altaf Bosan, national manager of the Expanded Programme on Immunisation, says the government is doing its part.

“The government is quite aware of the emotional and financial burden of this disease on families,” he tells IPS. “It has already introduced (the) HiB vaccine and the next to be introduced is the pneumococcal vaccine in the first quarter of 2011.”

The pneumococcal vaccine is currently available in Pakistan but is too expensive for most people. Bosan says that its introduction via the state health system vaccine “will not only reduce the pneumococcal disease burden in Pakistan, but will also significantly contribute” to the achievement of the fourth Millennium Development Goal (MDG), which is to reduce under-five mortality by two-thirds.

“In Pakistan, where access to quality health care is inadequate, the use of pneumococcal vaccine is important in preventing pneumonia,” emphasises Huma Khawar of Gavi Pakistan, which supports and finances vaccines in the world’s poorest countries, including Pakistan. It helped introduce HiB vaccine in Pakistan’s national immunisation programme. Bhutta acknowledges that the introduction of the costly vaccine is a step in the right direction.

Then again, official figures show that routine immunisation coverage in Pakistan is at just 47 percent. In part, this is because the health expenditure in the public sector is just 0.08 percent of the Gross Domestic Product (GDP). Says Bhutta, looking at the appalling numbers: “You cannot do public health on a prayer.”

He also says that until the routine immunisation coverage improves drastically, the country cannot hope to make significant strides in achieving the eight MDGs by 2015.

Kazi observes as well, “The rising food prices are going to exacerbate food security, taking a toll on the young ones. Vaccines alone cannot give these children a shot at life if other conditions remain unchanged.”

Zahida Ghafoor, for one, has taken to having her tubes tied just so she can keep her children fed and as healthy as possible. She did not tell her husband about this, she says. “With four children, the gnawing poverty and (increasing) food prices, my husband, who runs a small corner shop, is unable to feed us.”